Patent Application
20230114613
This document relates generally to neurostimulation and more particularly to a neurostimulation system that provides for efficient determination of stimulation and sensing parameters controlling evoking and sensing of neural responses.
Neurostimulation, also referred to as neuromodulation, has been proposed as a therapy for a number of conditions. Examples of neurostimulation include Spinal Cord Stimulation (SCS), Deep Brain Stimulation (DBS), Peripheral Nerve Stimulation (PNS), and Functional Electrical Stimulation (FES). Implantable neurostimulation systems have been applied to deliver such a therapy. An implantable neurostimulation system may include an implantable neurostimulator, also referred to as an implantable pulse generator (IPG), and one or more implantable leads each including one or more electrodes. The implantable neurostimulator delivers neurostimulation energy through one or more electrodes placed on or near a target site in the nervous system. An external programming device is used to program the implantable neurostimulator with stimulation parameters controlling the delivery of the neurostimulation energy.
In one example, the neurostimulation energy is delivered in a form of electrical pulses. The delivery is controlled using stimulation parameters that specify spatial (where to stimulate), temporal (when to stimulate), and informational (patterns of pulses directing the nervous system to respond as desired) aspects of the electrical pulses. Signals indicative of the patient's response to the delivery of the electrical pulses may be sensed for setting and adjusting the stimulation parameters. For example, a neural signal indicative of the patient's response may be sensed for verifying lead placement, optimizing the stimulation parameters, and/or closed-loop control of a neurostimulation therapy may be sensed to allow for closed-loop control of its delivery. Efficacy and safety of a neurostimulation therapy may depend on customization of initial settings for the patient and continuing adjustments of the settings for the patient's changing conditions, which in turn depend on proper sensing of the patient's responses to the therapy.
An example (e.g., “Example 1”) of a system for delivering neurostimulation to a patient using a plurality of electrodes is provided. The system may include a stimulation output circuit, a sensing input circuit, and a control circuit. The stimulation output circuit may be configured to deliver the neurostimulation to evoke responses from the patient using an evoking configuration defining a stimulation electrode set including electrodes selected from the plurality of electrodes. The sensing input circuit may be configured to sense one or more signals including the evoked responses using a recording configuration defining a sensing electrode set including electrodes selected from the plurality of electrodes. The control circuit may include a stimulation controller, a sensing controller, and a parameter adjuster. The stimulation controller may be configured to control the delivery of the neurostimulation using stimulation parameters including the evoking configuration. The sensing controller may be configured to control the sensing of the evoked responses using sensing parameters including the recording configuration. The parameter adjuster may be configured to determine an evoking-recording parameter set by evaluating a sequence of test evoking-recording parameter sets. The evoking-recording parameter set may include a set of the stimulation parameters suitable for controlling the stimulation output circuit to deliver the neurostimulation to evoke a target response and a set of the sensing parameters suitable for controlling the sensing input circuit to record the evoked target response.
In Example 2, the subject matter of Example 1 may optionally be configured such that the parameter adjuster is configured to determine the evoking-recording parameter set for controlling the stimulation output circuit and the sensing input circuit in deep brain stimulation.
In Example 3, the subject matter of any one or any combination of Examples 1 and 2 may optionally be configured such that the stimulation output circuit includes multiple stimulation channels, and the evoking configuration defines a different stimulation electrode set for each channel of the multiple stimulation channels to allow for simultaneous delivery of the neurostimulation using different stimulation electrode sets.
In Example 4, the subject matter of any one or any combination of Examples 1 to 3 may optionally be configured such that the sensing input circuit includes multiple sensing channels, and the recording configuration defines a different sensing electrode set for each channel of the multiple sensing channels to allow for simultaneous sensing of multiple signals using different sensing electrode sets.
In Example 5, the subject matter of Example 4 may optionally be configured such that the parameter adjuster is configured to evaluate multiple test evoking-recording parameter sets of the sequence of test evoking-recording parameter sets simultaneously using two or more sensing channels of the multiple sensing channels.
In Example 6, the subject matter of any one or any combination of Examples 1 to 5 may optionally be configured such that the evoking configuration further defines a fractionalization specifying a distribution of a current of the neurostimulation over the stimulation electrode set.
In Example 7, the subject matter of any one or any combination of Examples 1 to 6 may optionally be configured such that the stimulation electrode set includes electrodes selected from the plurality of electrodes for monopolar stimulation.
In Example 8, the subject matter of any one or any combination of Examples 1 to 7 may optionally be configured such that the stimulation electrode set includes electrodes selected from the plurality of electrodes for bipolar stimulation.
In Example 9, the subject matter of any one or any combination of Examples 1 to 8 may optionally be configured such that the stimulation electrode set includes electrodes selected from the plurality of electrodes for anodic stimulation.
In Example 10, the subject matter of any one or any combination of Examples 1 to 9 may optionally be configured such that the stimulation output circuit is configured to deliver pulses of the neurostimulation, and the stimulation controller is configured to control the delivery of the pulses using the stimulation parameters including the evoking configuration and waveform parameters defining waveform of the pulses.
In Example 11, the subject matter of any one or any combination of Examples 1 to 10 may optionally be configured such that the parameter adjuster is configured to identify an optimal evoking-recording parameter set from the sequence of test evoking-recording parameter sets.
In Example 12, the subject matter of any one or any combination of Examples 1 to 11 may optionally be configured such that the parameter adjuster is configured to reduce a number of the test evoking-recording parameter sets in the sequence of test evoking-recording parameter sets using prior information.
In Example 13, the subject matter of Example 12 may optionally be configured such that the parameter adjuster is configured to reduce a number of changes in the recording configuration in the sequence of test evoking-recording parameter sets.
In Example 14, the subject matter of any one or any combination of Examples 1 to 13 may optionally be configured such that the parameter adjuster is configured to evaluate each test evoking-recording parameter set of the sequence of test evoking-recording parameter sets by causing the stimulation output circuit to deliver a burst of neurostimulation pulses and the sensing input circuit to sense the one or more signals using the each test evoking-recording parameter set and to minimize a number of pulses in the burst of neurostimulation pulses while allowing for reliable sensing of the evoked target response.
In Example 15, the subject matter of any one or any combination of Examples 1 to 14 may optionally be configured such that each test evoking-recording parameter set in the sequence of test evoking-recording parameter sets includes a pair of the stimulation electrode set and the sensing electrode set, the sensing electrode set of the pair defined by an electrode type and a location relative to the stimulation electrode set of the pair.
An example (e.g., “Example 16”) of a method for delivering neurostimulation to a patient using a plurality of electrodes is also provided. The method may include delivering the neurostimulation to evoke responses from the patient using a stimulation output circuit and an evoking configuration defining a stimulation electrode set including electrodes selected from the plurality of electrodes, sensing one or more signals including the evoked responses using a sensing input circuit and a recording configuration defining a sensing electrode set including electrodes selected from the plurality of electrodes, controlling the delivery of the neurostimulation using stimulation parameters including the evoking configuration, controlling the sensing of the one or more signals including the evoked responses using sensing parameters including the recording configuration, and determining an evoking-recording parameter set by evaluating a sequence of test evoking-recording parameter sets. The evoking-recording parameter set may include a set of the stimulation parameters suitable for controlling the delivery of the neurostimulation to evoke a target response and a set of the sensing parameters suitable for controlling the sensing of the one or more signals to record the evoked target response.
In Example 17, the subject matter of determining the evoking-recording parameter set as found in Example 16 may optionally include determining the evoking-recording parameter set for deep brain stimulation.
In Example 18, the subject matter of determining the evoking-recording parameter set as found in Example 17 may optionally include determining the evoking-recording parameter set for recording evoked resonant neural activity (ERNA).
In Example 19, the subject matter of sensing the one or more signals as found in any one or any combination of Examples 16 to 18 may optionally include sensing multiple signals simultaneously using multiple sensing channels of the sensing input circuit and multiple sensing configurations each defining a different sensing electrode set including electrodes selected from the plurality of electrodes, and the subject matter of evaluating the sequence of test evoking-recording parameter sets as found in any one or any combination of Examples 16 to 18 may optionally include evaluating multiple test evoking-recording parameter sets simultaneously using the multiple sensing channels of the sensing input circuit.
In Example 20, the subject matter of delivering the neurostimulation as found in Example 19 may optionally include delivering the neurostimulation simultaneously using multiple stimulation channels of the stimulation output circuit and multiple evoking configurations each defining a different stimulation electrode set including electrodes selected from the plurality of electrodes, and the subject matter of evaluating the sequence of test evoking-recording parameter sets as found in Example 19 may optionally include evaluating multiple test evoking-recording parameter sets simultaneously using the multiple channels of the sensing input circuit and the multiple stimulation channels of the stimulation output circuit.
In Example 21, the subject matter of the evoking configuration as found in any one or any combination of Examples 16 to 20 may optionally include the stimulation electrode set including electrodes selected from the plurality of electrodes and a fractionalization specifying a distribution of a current of the neurostimulation over the stimulation electrode set.
In Example 22, the subject matter of any one or any combination of Examples 16 to 21 may optionally further include selecting the stimulation electrode set from a reference electrode of the plurality of electrodes and lead electrodes of the plurality of electrodes. The lead electrodes each include one or more contacts and incorporated onto a lead configured to be coupled to the stimulation output circuit. The subject matter of controlling the delivery of the neurostimulation as found in any one or any combination of Examples 16 to 21 may optionally include controlling an electrical current of the neurostimulation individually for each of the reference electrode and the contacts of the lead electrodes.
In Example 23, the subject matter of selecting the stimulation electrode set as found in Example 22 may optionally include one or more lead electrodes of the lead electrodes to function as a cathode for delivering the neurostimulation.
In Example 24, the subject matter of selecting the stimulation electrode set as found in Example 23 may optionally further include selecting the reference electrode to function as an anode for delivering the neurostimulation.
In Example 25, the subject matter of selecting the stimulation electrode set as found in Example 23 may optionally further include selecting one or more additional lead electrodes of the lead electrodes to function as an anode for delivering the neurostimulation.
In Example 26, the subject matter of selecting the stimulation electrode set as found in Example 23 may optionally further include selecting the reference electrode and one or more additional lead electrodes of the lead electrodes to function as an anode for delivering the neurostimulation.
In Example 27, the subject matter of determining the evoking-recording parameter set as found in any one or any combination of Examples 16 to 26 may optionally include optimizing the evoking-recording parameter set for evoking and recording a specified target response.
In Example 28, the subject matter of determining the evoking-recording parameter set as found in any one or any combination of Examples 16 to 26 may optionally include determining an evoking-recording configuration including a pair of the evoking configuration and the recording configuration and a stimulation waveform parameter set, and the subject matter of evaluating the sequence of test evoking-recording parameter sets as found in any one or any combination of Examples 16 to 26 may optionally include evaluating a sequence of test evoking-recording configurations and a sequence of test stimulation waveform parameter sets for each test evoking-recording configuration of the sequence of test evoking-recording configurations.
In Example 29, the subject matter of determining the evoking-recording parameter set as found in Example 28 may optionally include: evaluating the sequence of test evoking-recording parameter sets by delivering a burst of pulses of the neurostimulation and sensing the one or more signals according to each test evoking-recording parameter set of the sequence of test evoking-recording parameter sets; and selecting the evoking-recording parameter set from the sequence of test evoking-recording parameter sets based on a result of the evaluation.
In Example 30, the subject matter of the plurality of electrodes as found in Example 29 may optionally include lead electrodes incorporated onto one or more leads configured to be coupled to the stimulation output circuit, and the subject matter of evaluating the sequence of test evoking-recording parameter sets as found in Example 29 may optionally include evaluating test evoking-recording parameter sets including multiple evoking-recording configurations using electrodes selected from lead electrodes incorporated onto a lead of the one or more leads.
In Example 31, the subject matter of any one or a combination of Examples 29 and 30 may optionally further include minimizing a number of pulses in each burst of the bursts of pulses.
In Example 32, the subject matter of any one or a combination of Examples 29 to 31 may optionally further include determining a waveform for the pulses of the neurostimulation to minimize stimulus artifacts.
In Example 33, the subject matter of evaluating the sequence of test evoking-recording parameter sets as found in any one or any combination of Examples 29 to 32 may optionally include evaluating the sequence of test evoking-recording parameter sets according to a temporal order of the test evoking-recording parameter sets specified by the sequence of test evoking-recording parameter sets, and the subject matter of any one or any combination of Examples 29 to 32 may optionally further include determining the temporal order for reducing a duration of the evaluation of the sequence of test evoking-recording parameter sets.
In Example 34, the subject matter of determining the temporal order as found in Example 33 may optionally include minimizing a number of the evoking-recording configurations in the sequence of test evoking-recording parameter sets.
In Example 35, the subject matter of determining the temporal order as found in Example 33 may optionally include determining the evoking-recording configurations in the sequence of test evoking-recording parameter sets using prior information.
In Example 36, the subject matter of determining the temporal order as found in any one or any combination of Examples 33 to 35 may optionally include evaluating two or more evoking-recording configurations in the sequence of test evoking-recording parameter sets simultaneously using at least one of multiple sensing channels of the sensing input circuit and multiple stimulation channels of the stimulation output circuit.
In Example 37, the subject matter of determining the temporal order as found in any one or any combination of Examples 33 to 36 may optionally include minimizing a number of changes in the recording configuration in the sequence of test evoking-recording parameter sets.
In Example 38, the subject matter of determining the temporal order as found in Example 37 may optionally include determining the temporal order for evaluating all test stimulation parameter sets for each evoking-recording configuration before switching to next evoking-recording configuration in the sequence of test evoking-recording parameter sets.
In Example 39, the subject matter of determining the temporal order as found in Example 37 may optionally include determining the temporal order for evaluating all the test evoking-recording parameter sets having a common recording configuration before evaluating test evoking-recording parameter sets having a different recording configuration.
An example (e.g., “Example 40”) of a non-transitory computer-readable storage medium including instructions, which when executed by a system, cause the system to perform a method for delivering neurostimulation to a patient using a plurality of electrodes is also provided. The method may include delivering the neurostimulation to evoke responses from the patient using a stimulation output circuit and an evoking configuration defining a stimulation electrode set including electrodes selected from the plurality of electrodes, sensing one or more signals including the evoked responses using a sensing input circuit and a recording configuration defining a sensing electrode set including electrodes selected from the plurality of electrodes, controlling the delivery of the neurostimulation using stimulation parameters including the evoking configuration, controlling the sensing of the one or more signals including the evoked responses using sensing parameters including the recording configuration, and determining an evoking-recording parameter set by evaluating a sequence of test evoking-recording parameter sets. The evoking-recording parameter set may include a set of the stimulation parameters suitable for controlling the delivery of the neurostimulation to evoke a target response and a set of the sensing parameters suitable for controlling the sensing of the one or more signals to record the evoked target response.
Another example (e.g., “Example 41”) of a system for delivering neurostimulation to a patient using a plurality of electrodes is provided. The system may include a stimulation output circuit, a sensing input circuit, and a control circuit. The stimulation output circuit may be configured to deliver the neurostimulation to evoke responses from the patient using an evoking configuration defining a stimulation electrode set including electrodes selected from the plurality of electrodes. The sensing input circuit may be configured to sense one or more signals including the evoked responses using a recording configuration defining a sensing electrode set including electrodes selected from the plurality of electrodes. The control circuit may be configured to control the delivery of the neurostimulation using stimulation parameters defining the evoking configuration, to control the sensing of the evoked responses using sensing parameters defining the recording configuration, and to adjust the stimulation parameters and the sensing parameters according to a sequence of evoking-recording parameter sets each including a set of the stimulation parameters determined for controlling the stimulation output circuit to deliver the neurostimulation to evoke a target response and a set of the sensing parameters determined for controlling the sensing input circuit to record the evoked target response.
In Example 42, the subject matter of Example 41 may optionally be configured such that the control circuit is configured to determine an evoking-recording parameter set of the sequence of evoking-recording parameter sets for controlling the stimulation output circuit and the sensing input circuit in deep brain stimulation.
In Example 43, the subject matter of any one or any combination of Examples 41 and 42 may optionally be configured such that the stimulation output circuit includes multiple stimulation channels, and the evoking configuration defines a different stimulation electrode set for each channel of the multiple stimulation channels to allow for simultaneous delivery of the neurostimulation using different stimulation electrode sets.
In Example 44, the subject matter of any one or any combination of Examples 41 to 43 may optionally be configured such that the sensing input circuit includes multiple sensing channels, and the recording configuration defines a different sensing electrode set for each channel of the multiple sensing channels to allow for simultaneous sensing of multiple signals using different sensing electrode sets.
In Example 45, the subject matter of Example 44 may optionally be configured such that the control circuit is configured to evaluate multiple evoking-recording parameter sets of the sequence of evoking-recording parameter sets simultaneously using two or more sensing channels of the multiple sensing channels.
In Example 46, the subject matter of any one or any combination of Examples 41 to 45 may optionally be configured such that the evoking configuration further defines a fractionalization specifying a distribution of a current of the neurostimulation over the stimulation electrode set.
In Example 47, the subject matter of any one or any combination of Examples 41 to 46 may optionally be configured such that the stimulation electrode set includes electrodes selected from the plurality of electrodes for monopolar stimulation.
In Example 48, the subject matter of any one or any combination of Examples 41 to 47 may optionally be configured such that the stimulation electrode set includes electrodes selected from the plurality of electrodes for bipolar stimulation.
In Example 49, the subject matter of any one or any combination of Examples 41 to 48 may optionally be configured such that the stimulation electrode set includes electrodes selected from the plurality of electrodes for anodic stimulation.
In Example 50, the subject matter of any one or any combination of Examples 41 to 49 may optionally be configured such that the stimulation output circuit is configured to deliver pulses of the neurostimulation, and the control circuit is configured to control the delivery of the pulses using the stimulation parameters including the evoking configuration and waveform parameters defining waveform of the pulses.
In Example 51, the subject matter of any one or any combination of Examples 41 to 50 may optionally be configured such that the control circuit is configured to identify an optimal evoking-recording parameter set from the sequence of evoking-recording parameter sets.
In Example 52, the subject matter of any one or any combination of Examples 41 to 51 may optionally be configured such that the control circuit is configured to reduce a number of the evoking-recording parameter sets in the sequence of evoking-recording parameter sets using prior information.
In Example 53, the subject matter of Example 52 may optionally be configured such that the control circuit is configured to reduce a number of changes in the recording configuration in the sequence of evoking-recording parameter sets.
In Example 54, the subject matter of any one or any combination of Examples 41 to 53 may optionally be configured such that the control circuit is configured to evaluate each evoking-recording parameter set of the sequence of evoking-recording parameter sets by causing the stimulation output circuit to deliver a burst of neurostimulation pulses and the sensing input circuit to sense the one or more signals using the each evoking-recording parameter set and to minimize a number of pulses in the burst of neurostimulation pulses while allowing for reliable sensing of the evoked target response.
In Example 55, the subject matter of any one or any combination of Examples 41 to 54 may optionally be configured such that each evoking-recording parameter set in the sequence of evoking-recording parameter sets includes a pair of the stimulation electrode set and the sensing electrode set, the sensing electrode set of the pair defined by an electrode type and a location relative to the stimulation electrode set of the pair.
Another example (e.g., “Example 56”) of a method for delivering neurostimulation to a patient using a plurality of electrodes is also provided. The method may include delivering the neurostimulation to evoke responses from the patient using a stimulation output circuit and an evoking configuration defining a stimulation electrode set including electrodes selected from the plurality of electrodes, sensing one or more signals including the evoked responses using a sensing input circuit and a recording configuration defining a sensing electrode set including electrodes selected from the plurality of electrodes, controlling the delivery of the neurostimulation using stimulation parameters including the evoking configuration, controlling the sensing of the one or more signals including the evoked responses using sensing parameters including the recording configuration, and adjusting the stimulation parameters and the sensing parameters according to a sequence of evoking-recording parameter sets each including a set of the stimulation parameters determined for controlling the stimulation output circuit to deliver the neurostimulation to evoke a target response and a set of the sensing parameters determined for controlling the sensing input circuit to record the evoked target response.
In Example 57, the subject matter as found in Example 16 may optionally further include determining an evoking-recording parameter set of the sequence of evoking-recording parameter sets for deep brain stimulation.
In Example 58, the subject matter of determining the evoking-recording parameter set as found in Example 57 may optionally include determining the evoking-recording parameter set for recording evoked resonant neural activity (ERNA).
In Example 59, the subject matter of sensing the one or more signals as found in any one or any combination of Examples 56 to 58 may optionally include sensing multiple signals simultaneously using multiple sensing channels of the sensing input circuit and multiple sensing configurations each defining a different sensing electrode set including electrodes selected from the plurality of electrodes, and the subject matter as found in any one or any combination of Examples 56 to 58 may optionally further include evaluating multiple evoking-recording parameter sets of the sequence of evoking-recording parameter sets simultaneously using the multiple sensing channels of the sensing input circuit.
In Example 60, the subject matter of delivering the neurostimulation as found in Example 59 may optionally include delivering the neurostimulation simultaneously using multiple stimulation channels of the stimulation output circuit and multiple evoking configurations each defining a different stimulation electrode set including electrodes selected from the plurality of electrodes, and the subject matter of evaluating the sequence of evoking-recording parameter sets as found in Example 19 may optionally include evaluating multiple evoking-recording parameter sets simultaneously using the multiple channels of the sensing input circuit and the multiple stimulation channels of the stimulation output circuit.
In Example 61, the subject matter of the evoking configuration as found in any one or any combination of Examples 56 to 60 may optionally include the stimulation electrode set including electrodes selected from the plurality of electrodes and a fractionalization specifying a distribution of a current of the neurostimulation over the stimulation electrode set.
In Example 62, the subject matter of any one or any combination of Examples 56 to 61 may optionally further include selecting the stimulation electrode set from a reference electrode of the plurality of electrodes and lead electrodes of the plurality of electrodes. The lead electrodes each include one or more contacts and incorporated onto a lead configured to be coupled to the stimulation output circuit. The subject matter of controlling the delivery of the neurostimulation as found in any one or any combination of Examples 56 to 61 may optionally include controlling an electrical current of the neurostimulation individually for each of the reference electrode and the contacts of the lead electrodes.
In Example 63, the subject matter of selecting the stimulation electrode set as found in Example 62 may optionally include one or more lead electrodes of the lead electrodes to function as a cathode for delivering the neurostimulation.
In Example 64, the subject matter of selecting the stimulation electrode set as found in Example 63 may optionally further include selecting the reference electrode to function as an anode for delivering the neurostimulation.
In Example 65, the subject matter of selecting the stimulation electrode set as found in Example 63 may optionally further include selecting one or more additional lead electrodes of the lead electrodes to function as an anode for delivering the neurostimulation.
In Example 66, the subject matter of selecting the stimulation electrode set as found in Example 63 may optionally further include selecting the reference electrode and one or more additional lead electrodes of the lead electrodes to function as an anode for delivering the neurostimulation.
In Example 67, the subject matter of determining the evoking-recording parameter set as found in any one or any combination of Examples 56 to 66 may optionally include optimizing the evoking-recording parameter set for evoking and recording a specified target response.
In Example 68, the subject matter as found in any one or any combination of Examples 56 to 66 may optionally further include determining an evoking-recording configuration including a pair of the evoking configuration and the recording configuration and a stimulation waveform parameter set, and evaluating a sequence of evoking-recording configurations and a sequence of stimulation waveform parameter sets for each evoking-recording configuration of the sequence of evoking-recording configurations.
In Example 69, the subject matter of determining the evoking-recording parameter set as found in Example 68 may optionally include: evaluating the sequence of evoking-recording parameter sets by delivering a burst of pulses of the neurostimulation and sensing the one or more signals according to each evoking-recording parameter set of the sequence of evoking-recording parameter sets; and selecting the evoking-recording parameter set from the sequence of evoking-recording parameter sets based on a result of the evaluation.
In Example 70, the subject matter of the plurality of electrodes as found in Example 69 may optionally include lead electrodes incorporated onto one or more leads configured to be coupled to the stimulation output circuit, and the subject matter as found in Example 69 may optionally further include evaluating evoking-recording parameter sets including multiple evoking-recording configurations using electrodes selected from lead electrodes incorporated onto a lead of the one or more leads.
In Example 71, the subject matter of any one or a combination of Examples 69 and 70 may optionally further include minimizing a number of pulses in each burst of the bursts of pulses.
In Example 72, the subject matter of any one or a combination of Examples 69 to 71 may optionally further include determining a waveform for the pulses of the neurostimulation to minimize stimulus artifacts.
In Example 73, the subject matter of evaluating the sequence of evoking-recording parameter sets as found in any one or any combination of Examples 69 to 72 may optionally include evaluating the sequence of evoking-recording parameter sets according to a temporal order of the evoking-recording parameter sets specified by the sequence of evoking-recording parameter sets, and the subject matter of any one or any combination of Examples 69 to 72 may optionally further include determining the temporal order for reducing a duration of the evaluation of the sequence of evoking-recording parameter sets.
In Example 74, the subject matter of determining the temporal order as found in Example 73 may optionally include minimizing a number of the evoking-recording configurations in the sequence of evoking-recording parameter sets.
In Example 75, the subject matter of determining the temporal order as found in Example 73 may optionally include determining the evoking-recording configurations in the sequence of evoking-recording parameter sets using prior information.
In Example 76, the subject matter of determining the temporal order as found in any one or any combination of Examples 73 to 75 may optionally include evaluating two or more evoking-recording configurations in the sequence of evoking-recording parameter sets simultaneously using at least one of multiple sensing channels of the sensing input circuit and multiple stimulation channels of the stimulation output circuit.
In Example 77, the subject matter of determining the temporal order as found in any one or any combination of Examples 73 to 76 may optionally include minimizing a number of changes in the recording configuration in the sequence of evoking-recording parameter sets.
In Example 78, the subject matter of determining the temporal order as found in Example 77 may optionally include determining the temporal order for evaluating all stimulation parameter sets for each evoking-recording configuration before switching to next evoking-recording configuration in the sequence of evoking-recording parameter sets.
In Example 79, the subject matter of determining the temporal order as found in Example 77 may optionally include determining the temporal order for evaluating all the evoking-recording parameter sets having a common recording configuration before evaluating evoking-recording parameter sets having a different recording configuration.
Another example (e.g., “Example 80”) of a non-transitory computer-readable storage medium including instructions, which when executed by a system, cause the system to perform a method for delivering neurostimulation to a patient using a plurality of electrodes is also provided. The method may include delivering the neurostimulation to evoke responses from the patient using a stimulation output circuit and an evoking configuration defining a stimulation electrode set including electrodes selected from the plurality of electrodes, sensing one or more signals including the evoked responses using a sensing input circuit and a recording configuration defining a sensing electrode set including electrodes selected from the plurality of electrodes, controlling the delivery of the neurostimulation using stimulation parameters including the evoking configuration, controlling the sensing of the one or more signals including the evoked responses using sensing parameters including the recording configuration, and adjusting the stimulation parameters and the sensing parameters according to a sequence of evoking-recording parameter sets each including a set of the stimulation parameters determined for controlling the stimulation output circuit to deliver the neurostimulation to evoke a target response and a set of the sensing parameters determined for controlling the sensing input circuit to record the evoked target response.
This Summary is an overview of some of the teachings of the present application and not intended to be an exclusive or exhaustive treatment of the present subject matter. Further details about the present subject matter are found in the detailed description and appended claims. Other aspects of the disclosure will be apparent to persons skilled in the art upon reading and understanding the following detailed description and viewing the drawings that form a part thereof, each of which are not to be taken in a limiting sense. The scope of the present disclosure is defined by the appended claims and their legal equivalents.
The drawings illustrate generally, by way of example, various embodiments discussed in the present document. The drawings are for illustrative purposes only and may not be to scale.
In the following detailed description, reference is made to the accompanying drawings which form a part hereof, and in which is shown by way of illustration specific embodiments in which the invention may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the invention, and it is to be understood that the embodiments may be combined, or that other embodiments may be utilized, and that structural, logical and electrical changes may be made without departing from the spirit and scope of the present invention. References to “an”, “one”, or “various” embodiments in this disclosure are not necessarily to the same embodiment, and such references contemplate more than one embodiment. The following detailed description provides examples, and the scope of the present invention is defined by the appended claims and their legal equivalents.
This document discusses, among other things, a method and system for efficiently and effectively determining stimulation and sensing parameters for evoking and recording neural responses using a neurostimulation system. The neurostimulation system can control the sensing of neural signals including evoked responses and use the sensed signals as well as their relationship to stimulation parameters to determine and adjust settings for delivery of neurostimulation and settings for the sensing of neural signals. In various embodiments, the neuromodulation system can include an implantable device configured to deliver neurostimulation (also referred to as neuromodulation) therapies, such as deep brain stimulation (DBS), spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), and vagus nerve stimulation (VNS), and one or more external devices configured to program the implantable device for its operations and monitor the performance of the implantable device. While DBS is specifically discussed as an example, the present subject matter can be applied in various neurostimulation therapies in which neural signals including evoked potentials are sensed.
A neurostimulation system may sense neural signals including spontaneous activity and/or evoked potentials and depend on proper sensing for verifying lead and electrode placement, setting stimulation parameters controlling delivery of neurostimulation pulses for a therapy, and adjusting the stimulation parameters in responses to changing needs and/or conditions of a patient, among other things. Types of neural potentials to be sensed may depend on the type of therapy. For example, in DBS, to avoid undesirable side effects and ensure desirable clinical effects, neural signals may be sensed from the patient's internal brain structure within the limbic system to evaluate local field potentials (LFPs), within the basal ganglia to evaluate evoked potentials (EPs) including evoked resonant neural activity (ERNA), and/or within neocortical areas of the brain to evaluate sensory or motor EPs or motor LFPs signatures. One or more leads each including an array of electrodes may be used for delivering the neurostimulation pulses and sensing the neural signals. The selection of stimulation and sensing configurations, including selecting one or more stimulation electrodes from the array(s) of electrodes for delivering the neurostimulation pulses and selecting one or more sensing electrodes from the array(s) of electrodes for sensing the neural signals, may depend on each type of the neural signals that needs to be evaluated. A neurostimulation system that includes multiple stimulation and sensing channels individually programmable for connecting to different sets of electrodes allow for proper setting or optimization of stimulation and sensing configurations for each type of recorded neural signal, but the process may be time consuming given the numerous possible combinations of stimulation and sensing parameters, including the numerous possible combinations of electrodes selectable to be the stimulation and sensing electrodes. As evoking and recording of evoked neural responses can assist proper placement of electrodes and initial settings of a neurostimulator during an implantation operation, for example, there is a need for an efficient and effective strategy for determining the stimulation and sensing parameters.
The present subject matter provides for determining of the stimulation and sensing parameters suitable for evoking and recording targeted neural responses (including evoked or spontaneous activities) by evaluating various combinations of stimulation and sensing parameters, with various techniques used to reduce the time required for the evaluation. Examples of such techniques include using prior information including patient data and device capabilities to reduce or minimize the number of measurements in the evaluation, using spatial and temporal arrangement of the stimulation and sensing parameters to be evaluated to reduce or minimize total sensing circuit settlement time, etc. In various embodiments, the present subject matter can be applied during placement, adjustment, and operation of an implantable neurostimulation system to establish reliable sensing of targeted neural responses as required by various neurostimulation algorithms such as lead checking, sweet spot (stimulation site) searching, system functionality checking, closed-loop therapy control, and monitoring of effects of medications on evoked potentials.
In this document, a “user” includes a physician or other clinician or caregiver who examiners and/or treats the patient using system 100; a “patient” includes a person who receives or is intended to receive neurostimulation delivered using system 100. In various embodiments, the patient can be allowed to adjust his or her treatment using system 100 to certain extent, such as by adjusting certain therapy parameters and entering feedback and clinical effect information.
In various embodiments, programming device 102 can include a user interface 110 that allows the user to control the operation of system 100 and monitor the performance of system 100 as well as conditions of the patient including responses to the delivery of the neurostimulation. The user can control the operation of system 100 by setting and/or adjusting values of the user-programmable parameters.
In various embodiments, user interface 110 can include a graphical user interface (GUI) that allows the user to set and/or adjust the values of the user-programmable parameters by creating and/or editing graphical representations of various waveforms. Such waveforms may include, for example, a waveform representing a pattern of neurostimulation pulses to be delivered to the patient as well as individual waveforms that are used as building blocks of the pattern of neurostimulation pulses, such as the waveform of each pulse in the pattern of neurostimulation pulses. The GUI may also allow the user to set and/or adjust stimulation fields each defined by a set of electrodes through which one or more neurostimulation pulses represented by a waveform are delivered to the patient. The stimulation fields may each be further defined by the distribution of the current of each neurostimulation pulse in the waveform. In various embodiments, neurostimulation pulses for a stimulation period (such as the duration of a therapy session) may be delivered to multiple stimulation fields.
In various embodiments, system 100 can be configured for neurostimulation applications. User interface 110 can be configured to allow the user to control the operation of system 100 for neurostimulation. For example, system 100 as well as user interface 110 can be configured for DBS applications. Such DBS configuration includes various features that may simplify the task of the user in programming stimulation device 104 for delivering DBS to the patient, such as the features discussed in this document.
In various embodiments, the number of leads and the number of electrodes on each lead depend on, for example, the distribution of target(s) of the neurostimulation and the need for controlling the distribution of electric field at each target. In one embodiment, lead system 208 includes 2 leads each having 8 electrodes.
In various embodiments, user interface 310 can allow for definition of a pattern of neurostimulation pulses for delivery during a neurostimulation therapy session by creating and/or adjusting one or more stimulation waveforms using a graphical method. The definition can also include definition of one or more stimulation fields each associated with one or more pulses in the pattern of neurostimulation pulses. As used in this document, a “stimulation configuration” can include the pattern of neurostimulation pulses including the one or more stimulation fields, or at least various aspects or parameters of the pattern of neurostimulation pulses including the one or more stimulation fields. In various embodiments, user interface 310 includes a GUI that allows the user to define the pattern of neurostimulation pulses and perform other functions using graphical methods. In this document, “neurostimulation programming” can include the definition of the one or more stimulation waveforms, including the definition of one or more stimulation fields.
In various embodiments, circuits of neurostimulation 100, including its various embodiments discussed in this document, may be implemented using a combination of hardware and software. For example, the circuit of user interface 110, stimulation control circuit 214, programming control circuit 316, and stimulation control circuit 320, including their various embodiments discussed in this document, may be implemented using an application-specific circuit constructed to perform one or more particular functions or a general-purpose circuit programmed to perform such function(s). Such a general-purpose circuit includes, but is not limited to, a microprocessor or a portion thereof, a microcontroller or portions thereof, and a programmable logic circuit or a portion thereof.
Returning to
The electronic circuitry of IPG 404 can include a control circuit that controls delivery of the neurostimulation energy. The control circuit can include a microprocessor, a digital signal processor, application specific integrated circuit (ASIC), or other type of processor, interpreting or executing instructions included in software or firmware. The neurostimulation energy can be delivered according to specified (e.g., programmed) modulation parameters. Examples of setting modulation parameters can include, among other things, selecting the electrodes or electrode combinations used in the stimulation, configuring an electrode or electrodes as the anode or the cathode for the stimulation, specifying the percentage of the neurostimulation provided by an electrode or electrode combination, and specifying stimulation pulse parameters. Examples of pulse parameters include, among other things, the amplitude of a pulse (specified in current or voltage), pulse duration (e.g., in microseconds), pulse rate (e.g., in pulses per second), and parameters associated with a pulse train or pattern such as burst rate (e.g., an “on” modulation time followed by an “off” modulation time), amplitudes of pulses in the pulse train, polarity of the pulses, etc.
ETM 634 may be standalone or incorporated into CP 630. ETM 634 may have similar pulse generation circuitry as IPG 604 to deliver neurostimulation energy according to specified modulation parameters as discussed above. ETM 634 is an external device that is typically used as a preliminary stimulator after leads 408A and 408B have been implanted and used prior to stimulation with IPG 604 to test the patient's responsiveness to the stimulation that is to be provided by IPG 604. Because ETM 634 is external it may be more easily configurable than IPG 604.
CP 630 can configure the neurostimulation provided by ETM 634. If ETM 634 is not integrated into CP 630, CP 630 may communicate with ETM 634 using a wired connection (e.g., over a USB link) or by wireless telemetry using a wireless communications link 640. CP 630 also communicates with IPG 604 using a wireless communications link 640.
An example of wireless telemetry is based on inductive coupling between two closely-placed coils using the mutual inductance between these coils. This type of telemetry is referred to as inductive telemetry or near-field telemetry because the coils must typically be closely situated for obtaining inductively coupled communication. IPG 604 can include the first coil and a communication circuit. CP 630 can include or otherwise electrically connected to the second coil such as in the form of a wand that can be place near IPG 604. Another example of wireless telemetry includes a far-field telemetry link, also referred to as a radio frequency (RF) telemetry link. A far-field, also referred to as the Fraunhofer zone, refers to the zone in which a component of an electromagnetic field produced by the transmitting electromagnetic radiation source decays substantially proportionally to 1/r, where r is the distance between an observation point and the radiation source. Accordingly, far-field refers to the zone outside the boundary of r=λ/2π, where λ is the wavelength of the transmitted electromagnetic energy. In one example, a communication range of an RF telemetry link is at least six feet but can be as long as allowed by the particular communication technology. RF antennas can be included, for example, in the header of IPG 604 and in the housing of CP 630, eliminating the need for a wand or other means of inductive coupling. An example is such an RF telemetry link is a Bluetooth® wireless link.
CP 630 can be used to set modulation parameters for the neurostimulation after IPG 604 has been implanted. This allows the neurostimulation to be tuned if the requirements for the neurostimulation change after implantation. CP 630 can also upload information from IPG 604.
RC 632 also communicates with IPG 604 using a wireless link 340. RC 632 may be a communication device used by the user or given to the patient. RC 632 may have reduced programming capability compared to CP 630. This allows the user or patient to alter the neurostimulation therapy but does not allow the patient full control over the therapy. For example, the patient may be able to increase the amplitude of neurostimulation pulses or change the time that a preprogrammed stimulation pulse train is applied. RC 632 may be programmed by CP 630. CP 630 may communicate with the RC 632 using a wired or wireless communications link. In some embodiments, CP 630 is able to program RC 632 when remotely located from RC 632.
Implantable stimulator 704 may include a sensing input circuit (also known as a sensing circuit) 742 that provides the stimulator with a sensing capability, stimulation output circuit 212, a stimulation control circuit 714, an implant storage device 746, an implant telemetry circuit 744, a power source 748, and one or more electrodes 707. Sensing input circuit 742 senses one or more physiological signals for purposes of patient monitoring and/or feedback control of the neurostimulation. Examples of the one or more physiological signals include neural and other signals each indicative of a condition of the patient that is treated by the neurostimulation and/or a response of the patient to the delivery of the neurostimulation. Stimulation output circuit 212 is electrically connected to electrodes 706 through one or more leads 708 as well as electrodes 707, and delivers each of the neurostimulation pulses through a set of electrodes selected from electrodes 706 and electrode(s) 707. Stimulation control circuit 714 represents an embodiment of stimulation control circuit 214 and controls the delivery of the neurostimulation pulses using the plurality of stimulation parameters specifying the pattern of neurostimulation pulses. In one embodiment, stimulation control circuit 714 controls the delivery of the neurostimulation pulses using the one or more sensed physiological signals. Implant telemetry circuit 744 provides implantable stimulator 704 with wireless communication with another device such as CP 630 and RC 632, including receiving values of the plurality of stimulation parameters from the other device. Implant storage device 746 stores values of the plurality of stimulation parameters. Power source 748 provides implantable stimulator 704 with energy for its operation. In one embodiment, power source 748 includes a battery. In one embodiment, power source 748 includes a rechargeable battery and a battery charging circuit for charging the rechargeable battery. Implant telemetry circuit 744 may also function as a power receiver that receives power transmitted from an external device through an inductive couple. Electrode(s) 707 allow for delivery of the neurostimulation pulses in the monopolar mode. Examples of electrode(s) 707 include electrode 426 and electrode 418 in IPG 404 as illustrated in
In one embodiment, implantable stimulator 704 is used as a master database. A patient implanted with implantable stimulator 704 (such as may be implemented as IPG 604) may therefore carry patient information needed for his or her medical care when such information is otherwise unavailable. Implant storage device 746 is configured to store such patient information. For example, the patient may be given a new RC 632 and/or travel to a new clinic where a new CP 630 is used to communicate with the device implanted in him or her. The new RC 632 and/or CP 630 can communicate with implantable stimulator 704 to retrieve the patient information stored in implant storage device 746 through implant telemetry circuit 744 and wireless communication link 640, and allow for any necessary adjustment of the operation of implantable stimulator 704 based on the retrieved patient information. In various embodiments, the patient information to be stored in implant storage device 746 may include, for example, positions of lead(s) 708 and electrodes 706 relative to the patient's anatomy (transformation for fusing computerized tomogram (CT) of post-operative lead placement to magnetic resonance imaging (MRI) of the brain), clinical effect map data, objective measurements using quantitative assessments of symptoms (for example using micro-electrode recording, accelerometers, and/or other sensors), and/or any other information considered important or useful for providing adequate care for the patient. In various embodiments, the patient information to be stored in implant storage device 746 may include data transmitted to implantable stimulator 704 for storage as part of the patient information and data acquired by implantable stimulator 704, such as by using sensing input circuit 742.
In various embodiments, sensing input circuit 742, stimulation output circuit 212, stimulation control circuit 714, implant telemetry circuit 744, implant storage device 746, and power source 748 are encapsulated in a hermetically sealed implantable housing or case, and electrode(s) 707 are formed or otherwise incorporated onto the case. In various embodiments, lead(s) 708 are implanted such that electrodes 706 are placed on and/or around one or more targets to which the neurostimulation pulses are to be delivered, while implantable stimulator 704 is subcutaneously implanted and connected to lead(s) 708 at the time of implantation.
External telemetry circuit 852 provides external programming device 802 with wireless communication with another device such as implantable stimulator 704 via wireless communication link 640, including transmitting the plurality of stimulation parameters to implantable stimulator 704 and receiving information including the patient data from implantable stimulator 704. In one embodiment, external telemetry circuit 852 also transmits power to implantable stimulator 704 through an inductive couple.
In various embodiments, wireless communication link 640 can include an inductive telemetry link (near-field telemetry link) and/or a far-field telemetry link (RF telemetry link). For example, because DBS is often indicated for movement disorders which are assessed through patient activities, gait, balance, etc., allowing patient mobility during programming and assessment is useful. Therefore, when system 600 is intended for applications including DBS, wireless communication link 640 includes at least a far-field telemetry link that allows for communications between external programming device 802 and implantable stimulator 704 over a relative long distance, such as up to about 20 meters. External telemetry circuit 852 and implant telemetry circuit 744 each include an antenna and RF circuitry configured to support such wireless telemetry.
External storage device 818 stores one or more stimulation waveforms for delivery during a neurostimulation therapy session, such as a DBS therapy session, as well as various parameters and building blocks for defining one or more waveforms. The one or more stimulation waveforms may each be associated with one or more stimulation fields and represent a pattern of neurostimulation pulses to be delivered to the one or more stimulation field during the neurostimulation therapy session. In various embodiments, each of the one or more stimulation waveforms can be selected for modification by the user and/or for use in programming a stimulation device such as implantable stimulator 704 to deliver a therapy. In various embodiments, each waveform in the one or more stimulation waveforms is definable on a pulse-by-pulse basis, and external storage device 818 may include a pulse library that stores one or more individually definable pulse waveforms each defining a pulse type of one or more pulse types. External storage device 818 also stores one or more individually definable stimulation fields. Each waveform in the one or more stimulation waveforms is associated with at least one field of the one or more individually definable stimulation fields. Each field of the one or more individually definable stimulation fields is defined by a set of electrodes through a neurostimulation pulse is delivered. In various embodiments, each field of the one or more individually definable fields is defined by the set of electrodes through which the neurostimulation pulse is delivered and a current distribution of the neurostimulation pulse over the set of electrodes. In one embodiment, the current distribution is defined by assigning a fraction of an overall pulse amplitude to each electrode of the set of electrodes. Such definition of the current distribution may be referred to as “fractionalization” in this document. In another embodiment, the current distribution is defined by assigning an amplitude value to each electrode of the set of electrodes. For example, the set of electrodes may include 2 electrodes used as the anode and an electrode as the cathode for delivering a neurostimulation pulse having a pulse amplitude of 4 mA. The current distribution over the 2 electrodes used as the anode needs to be defined. In one embodiment, a percentage of the pulse amplitude is assigned to each of the 2 electrodes, such as 75% assigned to electrode 1 and 25% to electrode 2. In another embodiment, an amplitude value is assigned to each of the 2 electrodes, such as 3 mA assigned to electrode 1 and 1 mA to electrode 2. Control of the current in terms of percentages allows precise and consistent distribution of the current between electrodes even as the pulse amplitude is adjusted. It is suited for thinking about the problem as steering a stimulation locus, and stimulation changes on multiple contacts simultaneously to move the locus while holding the stimulation amount constant. Control and displaying the total current through each electrode in terms of absolute values (e.g. mA) allows precise dosing of current through each specific electrode. It is suited for changing the current one contact at a time (and allows the user to do so) to shape the stimulation like a piece of clay (pushing/pulling one spot at a time).
Programming control circuit 816 represents an embodiment of programming control circuit 316 and generates the plurality of stimulation parameters, which is to be transmitted to implantable stimulator 704, based on a specified stimulation configuration (e.g., the pattern of neurostimulation pulses as represented by one or more stimulation waveforms and one or more stimulation fields, or at least certain aspects of the pattern). The stimulation configuration may be created and/or adjusted by the user using user interface 810 and stored in external storage device 818. In various embodiments, programming control circuit 816 can check values of the plurality of stimulation parameters against safety rules to limit these values within constraints of the safety rules. In one embodiment, the safety rules are heuristic rules.
User interface 810 represents an embodiment of user interface 310 and allows the user to define the pattern of neurostimulation pulses and perform various other monitoring and programming tasks. User interface 810 includes a display screen 856, a user input device 858, and an interface control circuit 854. Display screen 856 may include any type of interactive or non-interactive screens, and user input device 858 may include any type of user input devices that supports the various functions discussed in this document, such as touchscreen, keyboard, keypad, touchpad, trackball, joystick, and mouse. In one embodiment, user interface 810 includes a GUI. The GUI may also allow the user to perform any functions discussed in this document where graphical presentation and/or editing are suitable as may be appreciated by those skilled in the art.
Interface control circuit 854 controls the operation of user interface 810 including responding to various inputs received by user input device 858 and defining the one or more stimulation waveforms. Interface control circuit 854 includes stimulation control circuit 320.
In various embodiments, external programming device 802 can have operation modes including a composition mode and a real-time programming mode. Under the composition mode (also known as the pulse pattern composition mode), user interface 810 is activated, while programming control circuit 816 is inactivated. Programming control circuit 816 does not dynamically updates values of the plurality of stimulation parameters in response to any change in the one or more stimulation waveforms. Under the real-time programming mode, both user interface 810 and programming control circuit 816 are activated. Programming control circuit 816 dynamically updates values of the plurality of stimulation parameters in response to changes in the set of one or more stimulation waveforms, and transmits the plurality of stimulation parameters with the updated values to implantable stimulator 704.
System 960 can be implemented in a neurostimulation system such as system 100 or 600. In various embodiments, system 960 is implemented in an implantable medical device, such as IPG 404, IPG 504, IPG 604, or implantable stimulator 704 as discussed in this document. For example, when system 960 is implemented in implantable stimulator 704, stimulation output circuit 212 can be configured to include stimulation circuit 912, sensing input circuit 742 can be configured to include sensing input circuit 942, and implant control circuit 714 can be configured to include control circuit 914. The plurality of electrodes using for delivering the neurostimulation can include electrodes 706 and 707. In various other embodiments, system 960 is implemented in an implantable medical device, such as IPG 404, IPG 504, IPG 604, or implantable stimulator 704 and an external programming device such as CP 630, RC 632, or external programming device 802 as discussed in this document. For example, when system 960 is implemented in implantable stimulator 704 and external programming device 802, stimulation output circuit 212 can be configured to include stimulation circuit 912, sensing input circuit 742 can be configured to include sensing input circuit 942, and implant control circuit 714 and interface control circuit 854 can be configured to include control circuit 914. In other words, control circuit 914 can be distributed in implant control circuit 714 and interface control circuit 854. The plurality of electrodes using for delivering the neurostimulation can include electrodes 706 and 707.
In various embodiments, the neurostimulation is delivered in the form of electrical stimulation pulses (referred to as neurostimulation pulses in this document), and system 960 is configured for delivering the neurostimulation pulses and sensing one or more signals including neural responses to the delivery of the neurostimulation pulses using the plurality of electrodes.
Referring back to
As discussed above, the evoking-recording parameter set to be determined by parameter adjuster 966 includes a set of the stimulation parameters, which includes the evoking configuration, and a set of the sensing parameters, which includes the recording configuration. In various embodiments, the evoking configuration defines a stimulation electrode set including electrodes selected from the plurality of electrodes. In various embodiments, the evoking configuration further defines a fractionalization specifying a distribution of a current of the neurostimulation over the stimulation electrode set. The fractionalization can assign fraction of an amplitude of the neurostimulation to each electrode in the stimulation electrode set. In various embodiments, the fractionalization can be used to create a single volume of activation or multiple volumes of activation by the neurostimulation. The single volume of activation can be used to evoke neural responses from a single neural target (e.g., a tissue volume, fiber tract, or structure) or area of overlapping targets. The multiple volumes of activation is used to evoke one or more types of neural responses from multiple neural targets. In various embodiments, stimulation controller 962 provides for multiple independent current control (MICC), which controls the current of the neurostimulation on each electrode of the plurality of electrodes. In various embodiments, the plurality of electrodes includes lead electrodes and at least one reference electrode (e.g., lead electrodes 1006-N and reference electrode 1107 as illustrated in
In various embodiments, parameter adjuster 966 can determine the evoking-recording parameter set for one or more algorithms related to the initial setting and/or adjustment of neurostimulation for a patient. Examples of such one or more algorithms include a lead checking algorithm for verifying lead (including electrodes) placement and/or functioning, a sweet spot searching algorithm for locating stimulation site(s), a sensing check algorithm for verifying functioning of the neurostimulation system for sensing evoked potentials, a closed-loop control algorithm for using sensed signal(s) to control the delivery of the neurostimulation, and/or a medication effect algorithm for monitoring effects of medications on evoked potentials. In one embodiment, parameter adjuster 966 determines the evoking-recording parameter set for one or more algorithms associated with a DBS therapy. In various embodiments, parameter adjuster 966 can determine the evoking-recording parameter set for any type of neurostimulation therapy where reliable sensing of evoked potentials is required.
In various embodiments, the evoking-recording parameter set to be determined using parameter adjuster 966 can include an evoking-recording configuration and a stimulation waveform parameter set. The evoking-recording configuration including a pair of the evoking configuration and the recording configuration. The stimulation waveform parameter sets including one or more adjustable stimulation waveform parameters to be used with the evoking-recording configuration. The sequence of test evoking-recording parameter sets to be evaluated using parameter adjuster 966 includes a sequence of test evoking-recording configurations and a sequence of test stimulation waveform parameter sets for each test evoking-recording configuration of the sequence of test evoking-recording configurations.
The evaluation of the sequence of test evoking-recording parameter sets can include a sequence of measurements each including evoking and recording of a neural response using a test evoking-recording parameter set. Parameter adjuster 966 can control the timing for each test evoking-recording parameter set to be evaluated. To evaluate each test evoking-recording parameter set, stimulation controller 962 can control stimulation output circuit 912 to deliver a burst of neurostimulation pulses, and sensing controller 964 can control sensing input circuit 942 to sense the one or more signals indicative of the response to the delivery of the burst of neurostimulation pulses. In various embodiments, parameter adjuster 966 can select the evoking-recording parameter set suitable for sensing evoked target responses from the sequence of test evoking-recording parameter sets based on a result of the evaluation. In various embodiments, parameter adjuster 966 can select a reliable evoking-recording parameter set for the evoked target responses using one or more sensing reliability criteria. Examples of such one or more sensing reliability criteria include an amplitude of the sensed evoked target response exceeding a threshold amplitude and a signal-to-noise ratio (SNR) of the sensed evoked target response exceeding a threshold SNR. In various other embodiments, the evoking-recording parameter set can be optimized for sensing the evoked target response, such as for a minimum stimulation energy to evoke the target response having an amplitude or SNR exceeding a threshold amplitude or SNR or for a maximum amplitude or SNR of evoked target response obtained using a specified stimulation energy. Parameter adjuster 966 can select an optimal evoking-recording parameter set for sensing the evoked target response from the sequence of test evoking-recording parameter sets.
The sequence of test evoking-recording parameter sets can include one or more test evoking-recording parameter sets each specifying a single electrode set for the stimulation electrode set and the sensing electrode set and one or more test evoking-recording parameter sets each specifying different electrode sets for the stimulation electrode set and the sensing electrode set. In various embodiments, the sensing electrode set in each test evoking-recording parameter set can be specified by an electrode type and a location relative to the stimulation electrode set. For example, when using the plurality of electrodes of
With respect to the stimulation electrode set, the sensing electrode set, and the fractionalization, it is noted that in some embodiments, the stimulation electrodes can be chosen so as to affect a single neural structure, population, region, target, fiber tract, or network. When referring to Volume of Tissue Activated (VTA), in some embodiments, the stimulation electrodes can be chosen to create a single continuous or single effective VTA. In this manner, the complex set of active stimulating electrodes can intend to elicit a single effective response, to be captured by the sensing electrodes. In other embodiments, and especially when performing multi-channel simultaneous stimulation and sensing, more than one area of neural tissue is intended to be modulated, especially simultaneously or in short succession. In this manner, multiple discontinuous or separate VTAs can be used. These can then be sensed simultaneously by one or more sensing electrode sets, collecting more than one set of information about the response to stimulation at the same time. In this manner, in some embodiments, a single response is recorded by one or more sensing channels, each channel including one or more electrodes, and in other embodiments, multiple responses are recorded by one or more sensing channels, either simultaneously or in short succession.
As shown in
In various embodiments, including these illustrated in
Using the evoking-recording configurations illustrated in
While one lead is used as an example in
Steps 1471-1475 of method 1470 can be performed in any temporal order that is logical and meaningful based on practical and design considerations. For example, steps 1473 and 1474 can be performed simultaneously, and each step can be repeatedly performed as needed until one or more satisfactory evoking-recording parameter sets are obtained.
At 1471, the neurostimulation is delivered to evoke responses from the patient using a stimulation output circuit and an evoking configuration. The evoking configuration defines a stimulation electrode set including electrodes selected from the plurality of electrodes. In various embodiments, the neurostimulation is delivered simultaneously through multiple stimulation channels of the stimulation output circuit using multiple evoking configurations each defining a different stimulation electrode set for use with one of the multiple stimulation channels. In various embodiments, in additional to the stimulation electrode set, the evoking configuration defines a fractionalization specifying a distribution of a current of the neurostimulation over the stimulation electrode set.
At 1472, one or more signals including the evoked responses are sensed using a sensing input circuit and a recording configuration. The recording configuration defines a sensing electrode set including electrodes selected from the plurality of electrodes. In various embodiments, multiple signals are sensed simultaneously through multiple sensing channels of the sensing input circuit using multiple sensing configurations each defining a different sensing electrode set for use with one of the multiple sensing channels. Multiple test evoking-recording parameter sets can be evaluated simultaneously using the multiple sensing channels of the sensing input circuit. In some embodiments, multiple test evoking-recording parameter sets can be evaluated simultaneously using the multiple sensing channels of the sensing input circuit and the multiple stimulation channels of the stimulation output circuit.
At 1473, the delivery of the neurostimulation is controlled using stimulation parameters including the evoking configuration. In various embodiments, the evoking configuration can include the stimulation electrode set selected from a reference electrode (e.g., reference electrode 1107) of the plurality of electrodes and lead electrodes (e.g., lead electrodes 1006-N) of the plurality of electrodes. In various embodiment, an electrical current of the neurostimulation can be controlled individually for each of the reference electrode and the lead electrodes (e.g., reference electrode 1107 or each of the 16 lead electrodes 1006-N). In various embodiments, selecting the stimulation electrode set for each evoking configuration can include, for example, selecting one or more lead electrodes of the lead electrodes to function as a cathode and
At 1474, the sensing of the one or more signals including the evoked responses is controlled using sensing parameters including the recording configuration. In various embodiments, the evoking configuration can include the sensing electrode set selected from the same plurality of electrodes from which the stimulation electrode set is selected from, i.e., the reference electrode (e.g., reference electrode 1107) and the lead electrodes (e.g., lead electrodes 1006-N). In various embodiments, the sensing electrode set can be specified by an electrode type (e.g., the ring electrode or the multi-segment electrode) and an electrode location relative to the stimulation electrode set used to evoke the response to be recorded using the sensing electrode set.
At 1475, an evoking-recording parameter set is determined by evaluating a sequence of test evoking-recording parameter sets. The evoking-recording parameter set includes a set of the stimulation parameters (including the evoking configuration) suitable for controlling the delivery of the neurostimulation to evoke a target response and a set of the sensing parameters (including the recording configuration) suitable for controlling the sensing of the one or more signals to record the evoked target response. In one embodiment, the evoking-recording parameter set is optimized for evoking and recording a specified target response. The evoking-recording parameter set can be optimized, for example:
Each test evoking-recording parameter set can include an evoking-recording configuration, which includes a pair of the evoking configuration and the recording configuration and a stimulation waveform parameter set. The evaluation of the sequence of test evoking-recording parameter sets can include evaluating a sequence of test evoking-recording configurations and a sequence of test stimulation waveform parameter sets for each test evoking-recording configuration of the sequence of test evoking-recording configurations. The sequence of test evoking-recording parameter sets can be evaluated by delivering a burst of pulses of the neurostimulation and sensing the one or more signals according to each test evoking-recording parameter set of the sequence of test evoking-recording parameter sets. The evoking-recording parameter set can be selected from the sequence of test evoking-recording parameter sets based on a result of the evaluation. In various embodiments, the sequence of test evoking-recording parameter sets include multiple evoking-recording configurations using different recording electrode sets selected from lead electrodes on each lead for recording the evoked target response.
Given the number of possible electrode combinations, testing all possible evoking-recording configurations as well as their combinations with possible stimulation waveform parameters with a patient, often in an operation room during device implantation and initial setting, is too time-consuming and hence impractical. The time required for evaluating the sequence of evoking-recording parameter sets also include, for example, the number of pulses required to evoke the target responses suitable for measurement and settlement of the sensing input circuit to allow for the measurement. In various embodiments, one or any combination of the following example methods can be applied for evaluating the sequence of test evoking-recording parameter sets in an efficient and effective manner:
It is to be understood that the above detailed description is intended to be illustrative, and not restrictive. Other embodiments will be apparent to those of skill in the art upon reading and understanding the above description. The scope of the invention should, therefore, be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.
This application claims the benefit of U.S. Provisional Application No. 63/255,165, filed on Oct. 13, 2021, which is hereby incorporated by reference in its entirety.
| Number | Date | Country | |
|---|---|---|---|
| 63255165 | Oct 2021 | US |
